When should a premature neonate (24-35 weeks) be discharged? five-year experience from a single-center neonatal intensive care unit in Türkiye.

Background/aim: The survival rate among preterm infants has improved, and hospital stays have been prolonged, consistent with positive developments in perinatal and neonatal care. The aim of this study was to provide evidence-based information for healthcare professionals concerning the ideal time for discharge by evaluating the reasons for prolonged hospital stays. Materials and methods: Six hundred eighty-one premature babies born at 24-35 weeks at the Mersin University Medical Faculty Hospital between January 2016 and May 2020 and admitted to the neonatal intensive care unit were included in the study following a retrospective file examination. Date of birth (gestational age) and discharge week (duration of hospital stay) calculated from the date of final discharge were recorded. Based on the literature, the ideal discharge time was determined to be 40 weeks according to postmenstrual age (week of birth + length of hospital stay). The primary variable was whether the infants were discharged before the ideal discharge week. The secondary variable was the effect of the presence of comorbidity on the length of hospital stay and ideal discharge time. Results: The mean hospital stay of preterm neonate born at 250-7-260-7, 270-7-280-7 and 290-7-300-7 weeks was significantly shorter in the absence of comorbidity than in the presence of comorbidity (p = 0.001, 0.004, and 0.008, respectively). More than half (53.5%) were discharged before the expected date of birth as gestational weeks increased, despite the prolonged length of stay in the presence of comorbidity. Conclusion: Health professionals can inform families that, in the absence of comorbidity, discharge is possible at an average of 36 weeks for 250-7-280-7-week gestational ages, and at an average of 34 weeks for 290-7-320-7-week gestational ages.

Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45-54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles.

Should Perirectal Swab Culture Be Performed in Cases Admitted to the Neonatal Intensive Care Unit? Lessons Learned from the Neonatal Intensive Care Unit.

Serial perirectal swabs are used to identify colonization of multidrug-resistant bacteria and prevent spread. The purpose of this study was to determine colonization with carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE). An additional purpose was to establish whether sepsis and epidemic associated with these factors were present in the neonatal intensive care unit (NICU), to which infants with hospital stays exceeding 48 h in an external healthcare center NICU were admitted. Perirectal swab samples were collected in the first 24 h by a trained infection nurse using sterile cotton swabs moistened with 0.9% NaCl from patients admitted to our unit after hospitalization exceeding 48 h in an external center. The primary outcome was positivity in perirectal swab cultures, and the secondary outcomes were whether this caused invasive infection and significant NICU outbreaks. A total of 125 newborns meeting the study criteria referred from external healthcare centers between January 2018 and January 2022 were enrolled. Analysis revealed that CRE constituted 27.2% of perirectal swab positivity and VRE 4.8%, and that one in every 4.4 infants included in the study exhibited perirectal swab positivity. The detection of colonization by these microorganisms, and including them within the scope of surveillance, is an important factor in the prevention of NICU epidemics.

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy.

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS: The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS: The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HIE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION: The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.

Burkholderia cepacia Complex Infections in Urgently Referred Neonates from Syrian Border Regions to a Hospital in Turkey: A Cross-Border Cluster.

Burkholderia cepacia complex (BCC) is a rare cause of sepsis in neonates, but infections are usually severe. It can be encountered unexpectedly when adequate health care is not provided. In this study, 49 neonatal cases with blood culture-proven BCC bacteremia within the first 72 h following admission to the neonatal intensive care unit between June 2017 and December 2018 were retrospectively analyzed in detail. All but one of the cases were born in Jarabulus, Al Bab, or Aleppo in Syria and were referred to Turkey due to urgent medical treatment needs. The rate of BCC bacteremia among the neonates transferred from across the border was 16.1% (48/297). The most common coexisting problems in the cases were multiple congenital malformations (12.2%), gastrointestinal system atresia (8.2%), and congenital heart diseases (4.1%). The median age at the time of their admission in Turkey was three days, and the median length of stay in another center before the referral was 11.5 h. The case fatality rate was 14.3%. In this study, a high rate of BCC infection and associated mortality was seen in neonates referred from cross-border regions. For centers accepting cases from conflict-affected regions, it is crucial to be careful regarding early detection of bacteremia, planning appropriate treatments, and preventing cross-contamination risks within the unit.

Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society.

OBJECTIVE: To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. MATERIAL AND METHODS: A prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived. RESULTS: Data from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. CONCLUSION: The present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

Acute peritoneal dialysis in neonatal intensive care unit: An 8-year experience of a referral hospital.

BACKGROUND: The aim of present study was to evaluate the indications, complications and outcomes of acute peritoneal dialysis (APD) in neonates at a referral university hospital during the previous 8 years. METHODS: This retrospective analysis included a total of 52 newborn infants who underwent APD in a neonatal intensive care unit between January 2008 and March 2016. Demographic, clinical, laboratory and microbiological data were extracted from patients' medical files. RESULTS: The primary causes for requiring APD were acute tubular necrosis (n = 36, 69.2%), inborn error of metabolism (n = 10, 19.2%), congenital nephrotic syndrome (n = 2, 3.9%), bilateral polycystic kidney (n = 2, 3.9%), renal agenesis (n = 1, 1.9%), and obstructive uropathy (n = 1, 1.9%). The mean duration of APD was 8.7 ± 15.87 days (range: 1-90 days). Procedural complications were mainly hyperglycemia (n = 16, 47.1%), dialysate leakage (n = 7, 20.6%), peritonitis (n = 3, 8.8%), catheter obstruction (n = 3, 8.8%), bleeding at the time of catheter insertion (n = 2, 5.9%), catheter exit site infection (n = 2, 5.9%), and bowel perforation (n = 1 2.9%). There were 40 deaths (76.9%), mainly due to underlying causes. Ten of the 12 survivors showed full renal recovery, but mild chronic renal failure (n = 1) and proteinuria with hypertension were seen (n = 1) in each of remaining patients. CONCLUSION: Peritoneal dialysis is an effective route of renal replacement therapy in the neonatal period for management of metabolic disturbances as well as renal failure. Although major complications of the procedure are uncommon, these patients still have a high mortality rate due to serious nature of the underlying primary causes.

Application of Flow Cytometry in the Early Diagnosis of Neonatal Sepsis.

GOALS: To raise awareness of the utility of flow cytometric detection of inflammatory markers in the early diagnosis of neonatal sepsis. PROCEDURES: In accordance with the Töllner scoring system, cases with ≥10 points are accepted as having "clinical sepsis" and cases with 0-4 points as having "no sepsis". The study group consisted of 50 newborns with clinical sepsis as well as a control group of 50 newborns without sepsis. In all cases, blood counts, C-reactive protein (CRP) levels, and procalcitonin (PCT) levels were recorded. Additionally, the "cluster of differentiation" (CD)64, CD11b, and CD62L adhesion molecules and the presence of the human leukocyte antigen HLA-DR on monocyte and neutrophil surfaces were examined by flow cytometry. RESULTS: The levels of acute-phase reactants CRP and PCT were significantly higher in the study group than in the control group (p<0.05). The cell adhesion molecules CD11b and CD64 and the human leukocyte antigen HLA-DR were significantly higher in the study group (p<0.05); CD62L levels were similar to those in the control group (p>0.05). Furthermore, receiver operating characteristic analysis indicated that neutrophil CD11b (nCD11b) is a diagnostic marker for neonatal sepsis (area under the curve [AUC]: 0.72, 95% confidence interval [CI]: 0.62-0.82, p<0.001). The sensitivity, specificity, and positive predictive value (PPV) for nCD11b were 72%, 68%, and 58.4%, respectively. Similarly, monocyte CD11b (mCD11b) positivity was found to be diagnostic (AUC 0.77, 95% CI: 0.68-0.87, p<0.001). The sensitivity and specificity for mCD11b were 72% and 68%, respectively. In addition, the sensitivity, specificity, and PPV for nHLA-DR were 62%, 60%, and 60.8%, respectively. CONCLUSION: In addition to acute-phase proteins, cell surface antigens such as CD11b, CD64, and HLA-DR should be used in routine investigations for the early diagnosis of neonatal sepsis. Such usage in combination with acute-phase reactants may enhance diagnostic accuracy.

Neonatal Gastrointestinal Perforations: the 10-Year Experience of a Reference Hospital.

The aim of this study was to present our experiences with, as well as the factors that affect, the treatment and outcome of patients with neonatal gastrointestinal perforations (GIPs). Thirty-eight newborn cases that were operated on for GIP in our hospital's tertiary newborn intensive care unit between January 2005 and December 2015 were retrospectively evaluated. The patients were divided into the two following groups: group 1, perforations related to necrotizing enterocolitis (NEC), and group 2, non-NEC perforations. In total, 38 patients (16 males, 22 females) participated in this study. The perforations were related to NEC in 12 patients (group 1; 31.6 %), and the other 26 patients (group 2; 68.4 %) were classified as non-NEC perforation cases. The incidence of neonatal GIP was 0.53 % in all newborn patients, while the incidence of perforation in NEC cases was 20 %. Of all patients, 25 (65.7 %) were premature. Non-NEC pathologies were the most common cause of GIP (68.4 %) and included stomach perforation related to a nasogastric catheter (n = 5), volvulus (n = 4), intestinal atresia (n = 3), esophageal atresia and tracheoesophageal fistula (n = 2), cystic fibrosis (n = 2), Hirschprung's disease (n = 2), appendicitis (n = 2), congenital stomach anterior wall weakness (n = 1), duplication cyst (n = 1), invagination (n = 1), incarcerated inguinal hernia (n = 1), and idiopathic causes (n = 2). Primary surgical repair was performed in all cases without a conservative approach. The mortality rate related to GIP in newborn cases was 47.3 %. While the mortality rate in group 1 was 66.6 %, it was statistically insignificantly lower in group 2 (38.4 %) (p > 0.05). In group 1, the mortality rate of those with intestinal and colorectal perforations was 45.6 and 20 %, respectively (p > 0.05). Non-NEC pathologies are the most frequent causes of GIP in newborns, and primary surgical repair is the primary treatment choice for neonatal GIP. However, GIP remains one of the most significant causes of mortality in newborns. While the prognosis for neonatal colon perforation is good, that for stomach and jejunoileal perforations is worse.

Magnesium-permeable TRPM6 polymorphisms in patients with meningomyelocele.

BACKGROUND: To evaluate whether there is an association between single nucleotide polymorphisms in magnesium-permeable TRPM6 ion channel and development of meningomyelocele (MMC). Therefore, we examined a total of 150 children with MMC, along with age- and gender-matched controls. DNA collected from whole blood was analyzed for the presence of two polymorphisms, rs2274924 (A > G; K1579E; Leu1579Glu) and rs3750425 (G > A; Val1393Ile), in TRPM6. Serum Mg2+ and calcium levels were also examined. RESULTS: A statistically significant difference in the distribution of rs2274924 genotypes (p = 0.049) was observed between the groups. Decreases in the AA genotype, and increases in the AG heterozygous genotype were also detected in the study group. The distribution of polymorphisms in the rs3750425 genotype and alleles was not statistically different between groups. Serum Mg2+ levels were lower in the GG genotype of rs3750425 compared with the GA and AA genotypes (p = 0.003). CONCLUSIONS: A statistically significant difference in rs3750425 genotypes was observed between the patients with MMC and the controls, which corresponded to lower serum Mg2+ concentrations in these patients. Taken together, these results suggest that genetic variations in the Mg2+-permeable TRPM6 ion channel may play a role in the etiopathogenesis of MMC during embryonic development.